Form FC-3 Quarterly Consolidated Foreign Currency Report

Form approved: OMB No. 1505-0014
Estimated average burden: 8 hours
Foreign Currency Form FC-3, expires 2/28/2013
U.S. Department of the Treasury

Data reported on this form will be held in confidence
(See Section A of the Instructions.)

QUARTERLY CONSOLIDATED FOREIGN CURRENCY REPORT
Report to the Federal Reserve Bank of ______________
(Amounts outstanding in millions of currency units as of the close
of business on the last business day of the month)

This report is required by law (31 U.S.C. 5315, C.F.R. 128, Subpart C). Failure to report
can result in a civil penalty up to $10,000 (31 U.S.C. 5321(a)(3), 31 C.F.R. 128.4 (C)).

Name of Reporting Institution

Date
As of

Categories
(1) Foreign exchange
contracts purchased

(2) Foreign exchange
contracts sold

(3) Foreign exchange
futures purchased

(4) Foreign exchange
futures sold

(5) Foreign currency
denominated assets

(6) Foreign currency
denominated liabilities

(1)
U.S.
DOLLARS

(2)
EUROS

(3)
SWISS
FRANCS

(4)
U.K.
POUNDS

(5)
JAPANESE
YEN

(6)
CANADIAN
DOLLARS

Foreign Currency form FC-3 – Page 2 of 2

OPTIONS ADDENDUM
(1)
U.S.

Categories

DOLLARS

(2)
EUROS

(3)
SWISS
FRANCS

(4)
U.K.
POUNDS

(5)
JAPANESE
YEN

(6)
CANADIAN
DOLLARS

(1) Put options written

(2) Call options written

(3) Call options purchased

(4) Put options purchased

(5) Net Fair value of
options above

Name of Officer (please print or type):

(Area code) telephone number:

Title of Officer:

Email address:

Signature of Officer:

_______________________________________________________
Name of primary contact (if different than above):

Email address:

(Area code) telephone number:

Before preparing this report, please read carefully
the General and Specific Instuctions to Form FC-3.
This report should be filed no later than 45 days
following the last business day of the calendar quarter.